Provider Demographics
NPI:1285044503
Name:DICKEY COUNTY SOCIAL SERVICE
Entity Type:Organization
Organization Name:DICKEY COUNTY SOCIAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-349-3271
Mailing Address - Street 1:205 15TH ST N
Mailing Address - Street 2:
Mailing Address - City:ELLENDALE
Mailing Address - State:ND
Mailing Address - Zip Code:58436-7600
Mailing Address - Country:US
Mailing Address - Phone:701-349-3271
Mailing Address - Fax:701-349-3277
Practice Address - Street 1:205 15TH ST N
Practice Address - Street 2:
Practice Address - City:ELLENDALE
Practice Address - State:ND
Practice Address - Zip Code:58436-7600
Practice Address - Country:US
Practice Address - Phone:701-349-3271
Practice Address - Fax:701-349-3277
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF DICKEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND50721Medicaid